Jussi M Kärkkäinen1, Giuliano Sandri1, Emanuel R Tenorio1, Amy Alexander2, Karen Bjellum1, Jane Matsumoto2, Jonathan Morris2, Bernardo C Mendes1, Randall R DeMartino1, Gustavo S Oderich3,4. 1. Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA. 2. Department of Radiology, Anatomic Modeling Laboratory, Mayo Clinic, Rochester, MN, USA. 3. Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA. oderich.gustavo@mayo.edu. 4. Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. oderich.gustavo@mayo.edu.
Abstract
BACKGROUND: Abdominal aortic aneurysm (AAA) models can be manufactured with 3D printing technology. This study describes detailed methodology and validation of endovascular aortic repair (EVAR) simulation using 3D printed AAA model connected to hemodynamic pump. METHOD: The AAA model was printed with Objet500 Connex3 (Stratasys, Eden Prairie, MN) and connected to BDC PD-0500 fluid pump (BDC Laboratories, Wheat Ridge, CO). EVAR procedure metrics were benchmarked in two expert implanters and compared to 20 vascular surgical trainees with different levels of EVAR experience (< 20 or ≥ 20 cases). All simulations were performed using commercially available stent grafts, guidewires, catheters, fluoroscopic guidance and digital subtraction angiography. Studied outcomes included ability to complete the procedure independently, time to deploy aortic component, ability to cannulate contralateral gate and complete the repair, and total fluoroscopy and procedure times. RESULTS: A total of 22 EVAR simulation procedures were performed with mean procedure time of 37 ± 12 min. Experienced trainees had significantly lower total procedural time (32 ± 9 vs. 44 ± 6 min, P = 0.003) and fluoroscopic time (13 ± 5 vs. 23 ± 8 min, P = 0.005). All experienced trainees completed the procedure independently in < 45 min, compared to six (46%) of those with less EVAR experience (P = 0.016). Among less experienced trainees, only two (15%) completed the entire procedure independently (P < 0.001). Benchmark implanters performed significantly better than both trainee groups in nearly all EVAR metrics. CONCLUSION: EVAR simulation was feasible and simulated all procedural steps with high fidelity. This model may be applicable for assessment of technical competencies and standard endovascular skill acquisition within vascular surgery training curricula.
BACKGROUND:Abdominal aortic aneurysm (AAA) models can be manufactured with 3D printing technology. This study describes detailed methodology and validation of endovascular aortic repair (EVAR) simulation using 3D printed AAA model connected to hemodynamic pump. METHOD: The AAA model was printed with Objet500 Connex3 (Stratasys, Eden Prairie, MN) and connected to BDC PD-0500 fluid pump (BDC Laboratories, Wheat Ridge, CO). EVAR procedure metrics were benchmarked in two expert implanters and compared to 20 vascular surgical trainees with different levels of EVAR experience (< 20 or ≥ 20 cases). All simulations were performed using commercially available stent grafts, guidewires, catheters, fluoroscopic guidance and digital subtraction angiography. Studied outcomes included ability to complete the procedure independently, time to deploy aortic component, ability to cannulate contralateral gate and complete the repair, and total fluoroscopy and procedure times. RESULTS: A total of 22 EVAR simulation procedures were performed with mean procedure time of 37 ± 12 min. Experienced trainees had significantly lower total procedural time (32 ± 9 vs. 44 ± 6 min, P = 0.003) and fluoroscopic time (13 ± 5 vs. 23 ± 8 min, P = 0.005). All experienced trainees completed the procedure independently in < 45 min, compared to six (46%) of those with less EVAR experience (P = 0.016). Among less experienced trainees, only two (15%) completed the entire procedure independently (P < 0.001). Benchmark implanters performed significantly better than both trainee groups in nearly all EVAR metrics. CONCLUSION: EVAR simulation was feasible and simulated all procedural steps with high fidelity. This model may be applicable for assessment of technical competencies and standard endovascular skill acquisition within vascular surgery training curricula.
Authors: R Kaufmann; C J Zech; M Takes; P Brantner; F Thieringer; M Deutschmann; K Hergan; B Scharinger; S Hecht; R Rezar; B Wernly; M Meissnitzer Journal: J Digit Imaging Date: 2022-01-07 Impact factor: 4.056
Authors: Callum D Little; Eleanor C Mackle; Efthymios Maneas; Debra Chong; Daniil Nikitichev; Jason Constantinou; Janice Tsui; George Hamilton; Roby D Rakhit; Tara M Mastracci; Adrien E Desjardins Journal: Int J Comput Assist Radiol Surg Date: 2022-04-10 Impact factor: 3.421